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Study of 8-year-old children with a history of respiratory syncytial virus bronchiolitis in infancy.

Thirty-five children known to have had respiratory syncytial virus bronchiolitis in infancy were examined at the age of 8 and their respiratory function tested. The results were compared with those in 35 controls matched for age, sex, and social class. Although 18 of the children who had had bronchiolitis in infancy had experienced subsequent episodes of wheezing, these were neither severe nor frequent in most cases and had apparently ceased by the age of 8. Nevertheless, the mean exercise bronchial lability of the children who had had bronchiolitis was significantly higher than that of the control children and the mean peak expiratory flow rate at rest significantly lower. Atopy, assessed by family and personal history alone, did not seem to be related to either bronchiolitis or wheezing episodes after bronchiolitis. The parents of the children who had had bronchiolitis smoked significantly more cigarettes during the infant's first year of life than those of the control children. The results suggest that bronchiolitis and childhood asthma are not closely related. Bronchial hyperreactivity might be inherited independently of atopy, but environmental factors seem the most likely link between severe respiratory infection in infancy and chronic or recurrent respiratory illness in adult life.

Asthma↗

[External respiratory function in echinococcosis].

The paper presents the results of a study of the parameters of external respiratory function in 33 patients with echinococcosis. Restrictive respiratory dysfunction was detected in 85.71% of the examinees. After inhalation tests, better parameters of external respiratory function were documented.

Adolescent↗

Perinatal predictors of respiratory symptoms and lung function at a young adult age.

A longitudinal cohort of 2,957 babies, born in 1975-1978, was used to investigate whether perinatal factors predict respiratory morbidity at a young adult age. In 1997, the presence of asthmatic (wheeze, nocturnal dyspnoea) and bronchitic (cough, phlegm, dyspnoea grade 3) symptoms and the level of lung function was determined in this cohort. The independent association between smoking during pregnancy, being first-born, birth weight and respiratory symptoms and lung function at young adult age was investigated using multiple regression models, taking other potential risk factors into account. Of 1,568 responders, 608 (39%, aged 18-22 yrs) had at least one respiratory symptom. The young adults who had a mother that smoked during pregnancy had a significantly lower level of lung function than their nonintra-uterine exposed peers (regression coefficient (B) (standard error): peak expiratory flow (PEF) -0.257 (0.131) L x s(-1); forced expiratory flow when 25% of the forced vital capacity has been exhaled (FEF25) -0.290 (0.129) L x s(-1)), although they were not at increased risk of having respiratory symptoms. Young adults who were first-born had better levels of lung function (B (SE): forced expiratory volume in one second (FEV1) 0.090 (0.042) L) and were less likely to have asthmatic symptoms (odds ratio (95%, confidence interval): 0.58 (0.35-0.95)) than those not first-born. Low birth weight (FEV1 -0.013 (0.004) L for a reduction of 100 g) was also predictive of reduced achieved levels of lung function at young adult age, independent of other potential risk factors, e.g. current smoking habits or familial predisposition. This study adds to the knowledge of the role of perinatal factors, such as smoking during pregnancy, as important predictors of respiratory morbidity.

Adolescent↗

[The prevalence of respiratory symptomes and immediate hypersensitivity reactions in a population exposed to flour and cereal dust in five flour mills in Morocco].

OBJECTIVE: To evaluate the prevalence of respiratory symptoms, ventilatory function disorder and immediate hypersensitivity reactions in a population exposed to flour and cereal dusts in five flour mills in Morocco. METHODS: The study of 373 exposed and 301 non-exposed subjects consisted of an analysis of working conditions and a medical survey. RESULTS AND CONCLUSION: The prevalence of clinical respiratory symptoms was 64.1% among exposed subjects and 41.2% among non-exposed subjects. Cough, expectoration, rhinitis, conjunctivitis, dermatitis, asthma and chronic bronchitis were more frequent among mill-workers. Spirometry was abnormal in 31.6% of those exposed: anomalies were found in both flow and volume. Among exposed subjects with a ventilatory disorder, 77.9% had only small airways syndrome or a light deficit. Smoking was the cause of excess morbidity. Skin prick tests were positive for at least one allergen in 65.4% of exposed compared to 27.2% non-exposed subjects. The prevalence of positive skin tests to occupational allergens alone was higher among those exposed (42.4%) than among the non-exposed (9.9%). The implementation of adequate medical and technical prevention may reduce this risk.

Adult↗

A clinicopathological study of fatal chronic airways obstruction.

A clinicopathological study of 21 patients who died as a result of chronic airways obstruction was carried out. Thirteen patients had been in right ventricular failure for at least one year before death and the other eight patients did not have right ventricular failure. The patients with long-standing right ventricular failure died at a younger age, on average, than those without failure. There were no significant quantitative differences between the two groups in the length of history of chest disease, blood gas estimations, respiratory function tests or degree of polycythaemia. The group with right ventricular failure had significantly larger mean right and left ventricular weights than the group without failure, but there were no significant differences in amounts of emphysema, size of bronchial mucous glands, proportion of small airways lumen in the lung or number of thick-walled peripheral lung vessels between the two groups. The findings did not support the division of this series of patients, with fatal chronic airways obstruction, into two distinct groups broadly defined as 'emphysematous' and 'bronchitic', either clinically or pathologically. A history of right ventricular failure correlated well with the finding of right ventricular hypertrophy at necropsy. Electrocardiographic evidence of right ventricular hypertrophy was found to correspond with the size of the right ventricle at necropsy in 66% of cases. The radiographic diagnosis of emphysema proved an accurate assessment when compared to the necropsy findings, and radiographic estimations of right ventricular enlargement were accurate in 65% of cases. Histological evidence of acute bronchitis was present in 20 of the 21 patients (95%), and five patients showed histological evidence of minor pulmonary thromboembolism. Ten patients in the series showed an increase in the weight of the left ventricular as well as the right ventricle.

Adult↗

A 3-year follow-up of asthmatic patients participating in a 10-week rehabilitation program with emphasis on physical training.

OBJECTIVE: To determine if asthmatic patients who had participated in a 10-week rehabilitation program with emphasis on physical training (1) continued with physical training, (2) maintained their improved cardiovascular condition and lung function, and (3) retained their good asthma control through the following 3 years. DESIGN: A descriptive 3-year follow-up study. PATIENTS AND SETTING: A convenience sample of 58 patients who had previously undergone a 10-week outpatient rehabilitation program were followed up 6 months and 1, 1.5, 2, and 3 years after the start of the program at a lung clinic in a university hospital. MAIN OUTCOME MEASURES: A training log was kept by each patient to record frequency, intensity, and mode of training. Physical condition was evaluated with a submaximal 6-minute ergometry test and a 12-minute walking test, respiratory function with static and dynamic spirometry, and bronchial hyperreactivity with a metacholine provocation test. Asthma symptoms and asthma control were measured with a study-specific questionnaire. RESULTS: Thirty-nine subjects (68%) exercised regularly during all 3 years. The cardiovascular condition and lung function values remained almost unchanged in all 58 patients. There was a significant decrease in number of emergency room visits the year after the 10-week rehabilitation program compared to the year before. It remained stable throughout the following 2 years. There was also a decrease in asthma symptoms in all patients, but the decrease was significant only in a subgroup of 26 patients, who exercised one or two times a week. CONCLUSIONS: It is possible for asthmatic subjects to exercise at a moderate intensity level on a long-term basis without deleterious effects. Moreover, the high compliance rate might indicate that inactive asthmatic patients who are taught how to exercise choose to continue to be physically active.

Adult↗

Response-dose ratio as an index of bronchial responsiveness to hypertonic saline challenge in an epidemiological survey of asthma in Polish children.

This epidemiological survey was done to evaluate the bronchial responsiveness (BHR) to a 4.5% hypertonic saline (HS) challenge in 13-14 year-old schoolchildren. BHR was measured by the response-dose ratio in which the response was estimated by the decline of FEV1 index of BHR (IxFEV1). Validity of the HS challenge test as a screening test for confirmation of reported asthma symptoms and the diagnosis of asthma was assessed. With a cutoff of 90th percentile of IxFEV1 in controls, the test sensitivity and specificity for asthma symptoms in the last 12 months was 44% and 90%, respectively. For the diagnosis of asthma the test sensitivity was 67% and specificity 90%. The mean log transform of IxFEV1 was significantly higher in children with more than three episodes of wheezing in the last 12 months and a diagnosis of asthma than in controls. Moreover, in the group with more than three episodes of asthma in the last 12 months the mean IxFEV1 was higher in girls than in boys. There was no gender difference in other groups of asthmatic children and controls. In Polish schoolchildren the prevalence of BHR to HS was 12.5% when adjusted to the prevalence of wheezing in the last 12 months. By multiple linear regression analysis, factors associated with BHR were serum levels of total IgE in children and of maternal IgE, as well as children's peripheral blood eosinophil counts. Also, the size of skin reaction to mite and dog allergens correlated with BHR.

Administration, Inhalation↗

Chronic cadmium poisoning in a pigment manufacturing plant.

When the working environment in a small cadmium-pigment manufacturing plant was investigated cadmium concentrations in respirable dust were found to be considerably above the hygiene standard recommended by the British Occupational Hygiene Society. Cadmium concentrations in blood and urine of exposed workers, both present and past employees, were determined. The six men who had worked in the production plant for seven years or more all showed signs of renal tubular damage. In addition two of these men exhibited exertional dyspnoea, and respiratory function tests showed evidence of pulmonary dysfunction. A third man showed moderate airways obstruction with mild symptoms. On the basis of the results of the investigations on individuals in this study, it is suggested that urinary cadmium concentrations should be kept below 15 microgram/day to avoid the possibility of renal damage, and that the insoluble respirable fraction of cadmium dust should not be regraded as merely nuisance dust.

Adult↗

Ciliary abnormalities in bronchial epithelium of smokers, ex-smokers, and nonsmokers.

Although respiratory changes induced by tobacco smoke have been extensively described, no study has focused on ciliary abnormalities associated with chronic smoking. Ciliary ultrastructure was studied in 37 adults with chronic sputum production (CSP) consisting of 13 current smokers (Group 1), 5 ex-smokers (Group 2), and 19 nonsmokers (Group 3). Five healthy nonsmokers constituted the control group (Group 4). Clinical and radiologic data and respiratory function tests were recorded. Acute respiratory infection was diagnosed by culture of tracheobronchial secretions obtained during bronchoscopy. Bronchial ciliated cells were obtained and processed for transmission electron microscopy. Within each group, the percentages of abnormal cilia were similar in patients with either chronic bronchitis or bronchiectasis and in patients with or without acute infection. The percentage of axonemal ultrastructural abnormalities (AUA) was higher in smokers (16.5% +/- 2.7%) and ex-smokers (17.5% +/- 7%) than in nonsmokers (5.2% +/- 1%) or control subjects (0.7% +/- 0.2%) (p < 0.0002). The AUA were polymorphic, characteristic of acquired ultrastructural changes. These results suggest that chronic smoking may induce an increased number of abnormal cilia which could participate in impairment of tracheobronchial clearance and which appears to be independent of the etiology of CSP.

Adult↗